Understanding and Fixing Diarrhea and Loose Stool

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons. In this week's episode, I'm going to be talking about diarrhea, what it is, the causes, and how to stop it, as well as loose or soft stools, which can have different causes than full-on diarrhea. But before I get started, if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. And if you haven't yet done my handy-dandy quiz on which gut or functional medicine tests would help you get to the root of your gut health or other health issues, check it out in the show notes. It's meant to help you find out what the perfect set of tests would be, assuming you had all the money in the world to spend on testing, given your symptoms and diagnoses. So please take it and send me any feedback you have about it at Lindsey Parsons. Lindsey@highdeserthealthcoaching.com. Now on to the show. Most people end up with diarrhea at least once a year. However, we usually chalk it up to eating or drinking something bad or a bout of intestinal flu or gastroenteritis, so we take some over-the-counter diarrhea medication or just wait it out and it usually goes away. But that's not always the end of it. I'll be discussing the short-term or acute type diarrhea as well as the potential causes of longer-term diarrhea or loose stool. The official definition of diarrhea is a condition of gastrointestinal upset or inflammation in which you have 2 to 3 or more loose or watery bowel movements a day. Acute diarrhea is diarrhea that lasts up to a week, but if it goes on for 2 to 3 weeks or more, it can be considered chronic. In most cases, it's happening because your body is trying to get rid of infections and toxins. So rather than slowing down your stool, it's better to drink water and electrolytes and just let your body do its job. It will remove the offending bacteria or parasites, but in the process, it will also rob you of important fluids, which you should try and replace or risk dehydration. So if your diarrhea is frequent and lasts more than a couple days, you should either buy a rehydration solution, make your own homemade one, or better yet, consume lots of liquids like homemade vegetable and fruit juices and smoothies, herbal teas, bone broth, or other types of broth, water with lemon or lime and raw honey, or sparkling water with fruit in it. For example, acute diarrhea is usually caused by either a parasitic protozoa of some sort, such as Cryptosporidium, Giardia, or Entamoeba histolica, or worms like roundworm, whipworm, tapeworm, or hookworms. Protozoan infections are either treated with prescription antiparasitics or herbal antiparasitics, and two of my favorite herbal ones are Cellcore Biosciences Para-1 and Para-2. Diarrhea can also come from viruses such as norovirus or rotavirus, and viral diarrhea is usually accompanied by nausea, vomiting, and fever, as well as stomach cramps. And these will typically pass on their own and don't require any special treatment other than staying hydrated and keeping up with your electrolytes. Another virus that may cause diarrhea is cytomegalovirus, which can include symptoms such as fatigue, fever, muscle aches, and sore throat. There are some good antiviral herbs though, if you want to try and speed up your healing, if you have some type of a viral infection. I'm especially fond of the BioCide line of products for this, in particular the BioCide and LSF and their OliVirux. Diarrhea can also come from certain types of bacteria like Salmonella, E. coli, Shigella, Campylobacter, and Clostridium difficile. Most bacterial infections will come from contaminated food or water and can be treated with antibiotics, or they might pass on their own. Clostridium difficile, or C. difficile, in contrast, is often caught in hospital settings after heavy antibiotic usage. And it exists in many of our healthy gut ecosystems, but when the competing and the balancing bacteria are decimated by the antibiotics, it can become pathogenic and overgrown. It will typically cause cramping and watery diarrhea many times a day and can become quite serious. About 15,000 people a year die of it in the US because it can lead to dehydration, severe intestinal inflammation, and enlarged colon and sepsis. So the first and second line treatments for C. diff are antibiotics, but if those fail, in the US you can now get a fecal transplant or a fecal microbiota transplant, also known known as FMT or poop transplant, sourced from a healthy donor, either in the form of capsules or inserted rectally with a retention enema. So with 2 to 3 treatments over the course of 2 to 3 days, depending on the modality, there's a greater than 90% success rate for FMT for curing C. diff. If you do have ongoing diarrhea and you're not sure if it could be a parasite or bacterial infection, you can ask your doctor for an ova and parasites test. If that comes up empty, which is often the case, but you still suspect a parasite or bacterial infection, which is of course a more likely scenario if you live in or have recently traveled to a developing country. A stool test like the GI-MAP by Diagnostic Solutions, or one of Genova's stool tests like the GI Effects or the Comprehensive Digestive Stool Analysis, or the GI 360 by Doctor's Data, will tell you whether that's the case. Unfortunately, those tests are not typically covered by insurance. Some symptoms that may help you differentiate a parasite from another type of problem is having trouble falling asleep or waking up frequently during the night, grinding your teeth at night, becoming more symptomatic during the full moon, skin issues like rashes, hives, rosacea, or eczema, pain or aching in your joints and muscles, fatigue, iron deficiency anemia, or not feeling full or satisfied after eating. A food sensitivity such as lactose intolerance or gluten intolerance or celiac disease, which is an autoimmune disease in which gluten causes an autoimmune attack on your intestines, could also be at the root of your diarrhea or loose stool. Often it's hard to determine if this is the case by simply stopping the food for a short period of time and reintroducing it because there may be damage and inflammation that has yet to be repaired over time to see the symptoms fade completely. For example, in celiac disease, the villi lining your small intestine, which absorb nutrients, may be blunted or worn down, which will impact your ability to absorb nutrients other than gluten, and in particular may cause a dairy sensitivity, which may cloud your ability to determine the root cause just through changing your diet. Celiac disease testing is easy to ask for from your doctor. However, other common symptoms of celiac disease include bloating, gas, fatigue, anemia, malnutrition, and osteoporosis. If you have a gluten sensitivity but not celiac disease, that's a bit tougher to test for, so it's best determined following a negative celiac test by using a 1-month elimination diet followed by a reintroduction of gluten over the course of several days, giving yourself at least a week to note if you see any symptoms. You can also be tested for lactose intolerance by your doctor, but the easiest way to find out, especially if you're very gassy or you have painful or burning mushy stool when you drink milk or eat soft cheeses or large quantities of hard cheeses, is to purchase a dairy digestant or lactase enzyme pill and just take it when you eat dairy products. If it helps, it's probably lactose intolerant, which is very common in adults. Of course, an unhealthy diet lacking in fiber and high in sugar, processed foods, alcohol, and caffeine can also lead to loose stool. And caffeine in particular, when people drink their morning coffee, that stimulates, uh, usually a bowel movement soon thereafter. Because this type of diet does create inflammation and dysregulates your blood sugar and feeds pathogenic bacteria, it can lead to dysbiosis, which can create loose stool. If you suspect your diet may be at the root of your issues, try a whole foods anti-inflammatory diet with healthy fats like avocados and olives and their oils, grass-fed butter or ghee, coconut oil and coconut products, organic and grass-fed meats, whole grains, root vegetables, beans and legumes, and plenty of fruits, vegetables, and herbs. I have clients whose digestive issues cleared up once they fixed their diet and their blood sugar became more balanced. Also be aware that a diet that's completely lacking in grains or starchy or root vegetables but falls short of a complete ketogenic diet can also lead to loose stool. So sometimes what seems to be a healthy diet may be at the root cause, and you may actually just need to sort of bulk up what you're eating with some more grains or starchy vegetables. Longer-term diarrhea or soft stool, especially when accompanied by bloating soon after you eat, is more likely to be caused by SIBO or small intestine bacterial overgrowth. This is often diagnosed by gastroenterologists as IBS, or irritable bowel syndrome, or IBS-D, with the D standing for diarrhea. SIBO can also be at play when you have long-term constipation or a pattern of constipation mixed with diarrhea, which is usually caused by what's called breakthrough diarrhea, where diarrhea is all that can get by the hard stool that's blocking your colon. SIBO, ironically, is often the result of food poisoning, which may have triggered the original diarrhea. The research of Dr. Mark Pimentel at Cedars-Sinai Medical Center has revealed that some people end up having an autoimmune attack on the cells that move food along the small intestine as a result of molecular mimicry following food poisoning. So when your body attacks the invader, it produces antibodies to common bacterial pathogens which are called anti-CDTB or anti-cytolytic distending toxin B antibodies. And because there's a protein in the gut called vinculin that looks similar to CDTB, your body may also produce antibodies to vinculin, which is an important protein for helping your small intestine motility. And these antibodies can stay elevated for many years following an attack of food poisoning. For example, my last bad attack of food poisoning that I recall was 25 years ago during my honeymoon, and I recently had my vinculin antibodies tested and they're still elevated. This autoimmune attack on the vinculin protein impacts your migrating motor complex, which is what clears food out of your small intestine every 1.5 to 2 hours. And when your migrating motor complex is impacted it results in stagnation and bacterial overgrowth. So in addition to diarrhea or loose stool, you'll often have bloating, heartburn, nausea, vomiting, and will feel full quickly when eating when SIBO is your root cause. If you recall about a food poisoning that may have kicked off your issues, the IBS Smart Test can tell you whether you have elevated antibodies. If it's positive, then you know there's likely bacteria that needs to be killed in your small intestine, which can be done through an antibiotic called Rifaximin or through herbal antimicrobials. It's also good to take a half tablespoon of partially hydrolyzed guar gum, also known or sold as SunFiber, in 8 ounces of water with each dose of either Rifaximin or the botanical antimicrobials for maximum success. SIBO breath testing may be recommended through a gastroenterologist, naturopath, or functional medicine practitioner, but I tend to shy away from that as it's not a terribly useful or reliable tool compared to other stool tests, in my opinion. And then really, the symptoms in history go a lot further in figuring out whether bloating, loose stools could be coming from SIBO. SIBO. Food poisoning isn't the only root cause, however, of diarrhea or loose stool caused by SIBO. Many other conditions can slow or inhibit small intestine motility, including traumatic brain injuries, hypothyroidism, diabetes, mold toxicity, adhesions following abdominal surgery, endometriosis, Ehlers-Danlos syndrome, and dysfunction of the ileocecal valve, which is the valve that separates the small and large intestines. And then medications like proton pump inhibitors, opiates, narcotics, antispasmodics, tricyclic antidepressants, and cholesteramine can also be at the root of SIBO. And of course, many functional digestive disorders relating to your basic digestive organs can also impact your body's ability to kill entering bacteria or adequately digest food so that there's not too much left over for the bacteria to reproduce on, such as hypochlorhydria or low stomach acid, low pancreatic enzymes, poor bile flow, low brush border enzymes, or low secretory IgA. Which is often the result of finding yourself in chronic fight or flight mode due to stress. I've also noticed that in clients with H. pylori, the bacteria that can cause ulcers and stomach cancer if it has certain what's called virulence factors, that after a while, while their secretory IgA may go high initially— and this is your gut immune system, right? So the secretory IgA will go high initially, but then it'll go low after a while, and then you'll see a good amount of dysbiosis and overgrowth of opportunistic bacteria like Streptococcus or Klebsiella, which can then cause loose stools. The long and short of it is, if you determine that SIBO is likely your root cause, you'll probably want to do something to kill the overgrown bacteria. While you're working on that, you may want to use a diet called low FODMAPs— that's F-O-D-M-A-P-S— for symptom relief, although I'm less set on recommending that these days since it's just really impractical because it eliminates onion and garlic as the primary things that you absolutely have to take out of your diet, which is really limiting when you're trying to eat anywhere but your own house under very strict conditions. In addition, if you determine that your SIBO is from elevated vinculin antibodies, then you'll need to think about taking something called a prokinetic before bed, most likely in the long term if not for life, which is something that keeps your small intestines moving. Two over-the-counter prokinetics that I've tried and have worked well for me are Iberogast and GI Motility Complex by Enzyme Science, and I'll link to those in the show notes. Other options include MotilPro by Pure Encapsulations, Sibo MCC by Priority One, and Motility Activator by Integrative Therapeutics. Common ingredients for these types of formulations include ginger and artichoke extracts, various herbs, and 5-HTP, or 5-hydroxytryptophan, which is a precursor to serotonin, which is involved in blood flow and motility in your gut. There are also prescription options for prokinetics, but to access those, you'll need a SIBO-literate doctor, and of course some exist, and if you have one, they will be able to help you out with those. One final note about prokinetics. If you're used to using something to slow your motility in your colon because of your diarrhea, the idea of taking something to increase motility may seem counterintuitive, but the thing is, prokinetics are meant to work on the small intestine to prevent stagnation upstream, which is causing your symptoms downstream. So don't let that scare you off. Another potential source of diarrhea is Candida overgrowth in the intestines, also known as SIFO, or small intestine fungal overgrowth. This often follows the use of heavy antibiotics in a clinical setting but can also happen to immune-suppressed individuals or people eating high-sugar or high-simple-carbohydrate diets who take broad-spectrum or many courses of antibiotics. There's various species of Candida, which are yeasts, and they're normal residents of our gut, but they can overgrow when all of the competing bacteria are decimated. Diarrhea or soft stool accompanied by sugar cravings, bloating, gas, burping, abdominal pain, nausea, yeast infections in women, and urinary tract infections can point to SIFO as a possible root cause. The only sure way to know if you have SIFO and invasive candidiasis is to take an organic acids test and see if a marker called arabinose is elevated. If that's the case, it's often accompanied by SIBO, and there are herbal antimicrobials that will take care of both bacteria and yeast at the same time. If it's just Candida, there are more Candida-specific natural treatments including fatty acids like undecenoic acid, caprylic acid, sold as Colorex, or black cumin seed oil, although I usually recommend those in conjunction with botanical antifungals. There are also various Candida diets out there, but people I really respect in the functional medicine field contend that going to extremes isn't necessary, and just the basics of removing added sugars and simple carbs while going through treatment is necessary. And I tend to agree because it can take several rounds, with a round lasting 6 to 8 weeks of antifungals, to get Candida in check. And it can be pretty tough to stick that out, even just, just keeping the sugar and the simple carbs away over the— over that long term, not to mention a much more complex complex and difficult diet. One of the remaining most common causes of chronic diarrhea is inflammatory bowel disease, or IBD, which can be broken into colitis, of which there's various forms including ulcerative colitis and microscopic colitis, and Crohn's disease. This is especially likely if you see blood in your stool, have unintended weight loss, abdominal pain and cramping, a reduced appetite, or fatigue. Usually IBD is diagnosed using a colonoscopy or endoscopy. But there's also markers from stool that are indicative of IBD and inflammation, which are lactoferrin and calprotectin. Calprotectin can be found on the GI Map test, which I often use with clients, and either are good markers for differentiating IBD from IBS or SIBO. Although keep in mind that many people present with both of those conditions at the same time. I've got other podcasts that go into much more detail on IBD, so if you want more info on that, check out episodes 15, 35, and 54 in particular. There are of course other potential causes of diarrhea or loose stool, such as liver and gallbladder issues, which can be supported through digestive enzymes and ox bile supplements or liver detoxification supplements like NAC or N-acetyl cysteine. Hyperthyroidism is another potential cause, which would be suspect if you have a rapid or irregular heartbeat, nervousness, anxiety, or irritability, or unintentional weight loss. And then certain medications and supplements can cause loose stool. In terms of supplements, the most common that will loosen your stool are large doses of vitamin C or certain forms of magnesium like magnesium oxide or magnesium citrate. For prescription medications, you can just check the inserts or online to see if diarrhea is a common side effect. Now, no matter what the cause of your diarrhea or soft stool, one supplement that I'm currently enamored with to help solve this problem is butyrate. Older forms of it are called sodium butyrate or magnesium butyrate and tend to be kind of smelly and not as effective. Newer forms, including Tributyrin and ProButyrate, don't have that issue with smell and are released further on in the intestines, which helps slow motility in the large intestine, resulting in firmer stools. I have found a few forms that I've been recommending, including the probuterate, which is in capsules, Aurax, that's A-U-R-A-X, which is a powder, or Tributrin-X. And when you first start these, you sometimes have to take a bunch, like 3, 2 to 3 times a day of the Tributrin-X, or a couple scoops of the Aurax 2 or 3 times a day, or 3 or 4 probuterate 2 to 3 times a day, just to get your stool to initially firm up. And then after that, you can usually start tapering down to a good maintenance dose. Now, of course, I would be remiss not to mention that butyrate is produced by bacteria when they ferment fiber. So of course, eating a high-fiber diet, meaning more beans and legumes, whole grains, root vegetables, and other fruits and veggies, could produce the same effect. And fiber supplements are also an option. Psyllium husk fiber is an old favorite for me, although it's kind of gross to take no matter how you mix it up. But if you put a tablespoon of that twice a day in 8 ounces of water or juice, it will very likely bulk up and firm up your stool and will certainly be less expensive than butyrate supplements. Now, if dysbiosis is at the root of your loose stool, probiotics may be helpful, either from your food or in supplement format. Generally, if you're looking to try a probiotic consisting of lactobacilli or Bifidobacteria, you should look at something in the 50 billion CFU range and up to correct minor dysbiosis. VisBiome has been validated in the research for this in particular and can be purchased in super high dose packets of 450 billion CFU or lower dose capsules. And spore-based or soil-based strains from the bacillus family are also known for their ability to help reshape a dysbiotic microbiome. And then S. boulardii, a beneficial yeast also sold as a probiotic, is particularly known for its ability to help prevent traveler's diarrhea. And of course, eating fermented foods like sauerkraut, kimchi, yogurt, kefir, and kombucha can help bring a dysbiotic microbiome into balance over time, as well as help stabilize your immune system, provide vitamins, regulate your metabolism, decrease obesity and chances of inflammatory diseases such as IBD. So obviously, if you're suffering from long-standing diarrhea or soft stool and you don't know why, that's the kind of thing I specialize in. You can set up a free 30-minute breakthrough session to talk to me. I can let you know if I think I can help you and tell you about my 5-appointment gut healing program, and you can decide if that seems like a good fit. Or you can just sign up for a single appointment too. The links for that are in the show notes. If you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my gut healing Facebook group, or join my newsletter list at HighDesertHealthCoaching.com. And while I'm not terribly active in the other forms of social media, you can also find me on Twitter, Instagram, and Pinterest. You'll find all that in the show notes. Thanks for listening today, and here's wishing you all the perfect stool.